title: Clinical and bacteriological profile and outcome of sepsis in dermatology ward in tertiary care center in New Delhi.
abstract: BACKGROUND
  There is paucity of data regarding the clinical and bacteriological profile of sepsis in dermatology in-patients.
  
  
  OBJECTIVE
  To study the frequency, etiology, and outcome of sepsis dermatology in-patients.
  
  
  METHODS
  The study was conducted in a 30-bedded dermatology ward of a tertiary care center. Sepsis was defined by presence of ≥2 SIRS (systemic inflammatory response syndrome) criteria along with evidence of infection (clinically obvious/culture proven infection of skin or internal organs). Patients were also assessed for known (common) risk factors of sepsis. In suspected sepsis patients, at least two samples of blood cultures by venepuncture were taken. Pus, skin swab, urine, and sputum samples were also collected for culture as needed with avoidance of contamination.
  
  
  RESULTS
  Among 860 admitted patients studied from November 2004 to July 2006, 103 (12%) fulfilled SIRS criteria. Of these, 63 had nonsepsis causes of SIRS positivity, while 40 (4.65%) had sepsis. Majority of the sepsis patient had vesicobullous diseases (42.5%), erythroderma (25%), toxic epidermal necrolysis (TEN) (22.5%). Severe sepsis developed in 17 (42.5%) patients, while 15 (37.5%) died. Methicillin-resistant Staphylococcus aureus (MRSA) was the commonest organism isolated (99; 25.9%) in all culture specimens followed by Acinetobacter spp. (52; 13.6%), Pseudomonas spp. (40; 10.5%), Methicillin-sensitive S. aureus (MSSA: 33; 8.7%), and Klebsiella spp. (22; 5.8%). Various risk factors affecting mortality and sensitivity patterns for various isolates were also analyzed.
  
  
  CONCLUSIONS
  Sepsis occurred in 40 (4.65%) inpatients in dermatology ward. The frequency of sepsis was highest in TEN (90%), followed by drug-induced maculopapular rash (20.0%), erythroderma (17.5%), and vesicobullous diseases (8.5%). MRSA, acinetobacter, pseudomonas, MSSA, and Klebsiella were important etiological agents involved in sepsis in dermatology in-patients.
authors.affiliation: Department of Dermatology and Venereology, All India Institute of Medical Sciences, New Delhi 110 029, India.
authors.forename: D P
authors.initials: DP
authors.lastname: Asati
authors.forename: V K
authors.initials: VK
authors.lastname: Sharma
authors.forename: S
authors.initials: S
authors.lastname: Khandpur
authors.forename: G C
authors.initials: GC
authors.lastname: Khilnani
authors.forename: A
authors.initials: A
authors.lastname: Kapil
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001431:Bacteriological Techniques; D002648:Child; D002675:Child, Preschool; D003880:Dermatology / Q000379:methods; D005260:Female; D006748:Hospital Departments / Q000379:methods; D006760:Hospitalization; D006801:Humans; D007194:India; D007223:Infant; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D018805:Sepsis / Q000382:microbiology* / Q000473:pathology / Q000628:therapy*; D018746:Systemic Inflammatory Response Syndrome / Q000382:microbiology* / Q000473:pathology / Q000628:therapy*; D016896:Treatment Outcome; D055815:Young Adult